Endovascular aneurysm repair (EVAR) yields better results than open surgical repair (OSR) in high risk patients with similar costs, according to a one-year trial study which appears in the October issue of the Journal of Vascular Surgery, published by the Society for Vascular Surgery.
Data was collected from 342 patients who had an abdominal aortic aneurysm (AAA) of more than 5.5 centimeters and required elective AAA repair at London Health Sciences Center (LHSC), London, Ontario, Canada, where EVAR has been used since 1997. Of the 192 patients at a high risk of postoperative complications, 140 received EVAR and 52 had OSR.
In this one-year non-randomized prospective study, demographic, medical, health care resource utilization, cost and quality of life data were collected to determine incremental costs and effects associated with each of these procedures. Sensitivity analyses were conducted to extrapolate the one-year mortality results to a five-year time horizon under various assumptions regarding convergence of mortality rates and re-intervention rates (for EVAR patients only).
"Even with similar baseline characteristics, postoperative complications occurred more frequently in OSR patients at a high-risk of surgical complications," said Dr. Guy De Rose, MD, medical director of surgical care at LHSC and an associate professor of surgery from the division of vascular surgery at the University of Western Ontario in London, Ontario, Canada. "The 30-day mortality rates were 0.7 percent for EVAR and 9.6 percent for OSR and significantly fewer EVAR patients had postoperative complications such as pulmonary edema, pneumonia or sepsis. In addition, the EVAR patients spent less time in the hospital and were less likely to be admitted to the ICU."
Dr. De Rose noted that, despite the cost of the endograft (approximately $10,000), the total average initial costs of hospitalization for high risk EVAR and OSR patients were similar ($28,139 vs. $31,181 respectively). He added that total one-year medical and indirect costs also were similar at $34,146 vs. $34,170 respectively. At one-year, all cause mortality was statistically lower in EVAR patients (7.1% vs. 17.3%). Five-year extrapolations indicated that EVAR may be cost-effective compared to OSR in high-risk patients over the long-term.
"Our study found that EVAR was a cost-effective strategy compared to OSR in high risk patients and had lower postoperative complications and lower mortality rates," said Dr. De Rose. He added that the quality of life experienced by the participating patients was similar between the two groups during the year following surgery.
"We are continuing to collect data on these patients and the longer-term results will provide more information regarding the cost-effectiveness of EVAR compared to OSR in high risk patients," explained Dr. De Rose.
The LHSC collaborated with the Programs for Assessment of Technology in Health (PATH) Research Institute, St Joseph's Healthcare Hamilton/McMaster University in Hamilton, Ontario, Canada on the current study. This study was conducted at the request of the Ontario Ministry of Health and Long-Term Care to provide evidence to the Ontario Health Technology Advisory Committee to support policy recommendations regarding the use of EVAR in Ontario.
About Cardiovascular Disease
Cardiovascular disease is a broad term that includes several more specific cardiovascular conditions. Cardiovascular disease is the leading killer in the US.
Common heart conditions include:
Arrhythmias. Irregular, or abnormally fast or slow, beating of the heart. The heart beat is controlled by electrical impulses. When the timing or frequency of these electrical impulses are disrupted, arrhythmias develop. Some arrhythmias are quite serious. An example is ventricular fibrillation, a severely abnormal heart rhythm that causes death unless treated right away by providing an electrical shock to the heart (called defibrillation). Others are less severe but can develop into more serious conditions over time. A particular concern is atrial fibrillation. Atrial fibrillation is rapid, irregular beating of the upper chambers of the heart. The chambers can quiver instead of beating in a regular pattern. Blood is not fully pumped out of them and may pool and clot.
Cardiomyopathy. A weakening of the heart muscle or a change in heart muscle structure. It often results in inadequate heart pumping or other heart function abnormalities. These can result from various causes, including prior heart attacks, viral or bacterial infections, and others.
Congenital Heart Disease. Malformations of heart structures, present during pregnancy or at birth. These may be caused by genetic factors or by adverse exposures during pregnancy. Examples include holes in the walls that divide the heart chambers, abnormal heart valves, and others. Congenital heart defects can disrupt the normal flow of blood through the heart. Congenital heart defects are the most common type of major birth defect.
Coronary Heart Disease (CHD). CHD is the most common type of heart disease. CHD occurs when the coronary arteries, that supply blood to the heart muscle, become hardened and narrowed due to the plaque buildup. The plaque buildup and the narrowing and hardening of the arteries is called atherosclerosis. Plaques are a mixture of fatty substances including cholesterol and other lipids. Blood flow and oxygen supply to the heart can be reduced or even fully blocked with a growing plaque. Plaques may also rupture and cause blood clots that block arteries. CHD can lead to a heart attack. Angina, the most common symptom of CHD can also occur. Angina is chest pain or discomfort that occurs when the heart muscle is not getting enough blood. Irregular heart beats, called arrhythmias, can develop.Over time, CHD can weaken the heart muscle and lead to heart failure, a serious problem where the heart cannot pump blood the way that it should.
Heart Attack. A heart attack , also called a myocardial infarction may occur when blood supply to the heart is severely reduced or completely blocked. When blood flow is restricted the heart muscle cells do not receive enough oxygen and begin to die. The more time that passes without treatment to restore blood flow, the greater the damage to the heart. This damage can cause irregular heart rhythms or even sudden cardiac arrest or stopping of the heart beat. Death can result. Coronary artery disease is the chief underlying cause of a heart attack. A less common cause of a heart attack is a severe spasm of a coronary artery that reduces the blood supply to the heart.
Heart Failure. This may also be called congestive heart failure or chronic heart failure. Heart failure is a condition where the heart cannot pump enough blood and oxygen to meet the needs of other body organs. Heart failure does not mean that the heart has stopped, but that it cannot pump blood the way that it should. Heart failure is a serious condition. There is no cure for heart failure at this time, except a heart transplant. Once diagnosed, medicines are needed for the rest of the person's life.
Peripheral Arterial Disease (PAD). Hardening of the arteries that supply blood to the arms and legs. PAD is usually the result of atherosclerosis, the buildup of plaque and narrowing of the arteries. Blood flow and oxygen to the muscles in the arms and legs can be reduced or even fully blocked. Painful leg muscles, numbness, swelling in the ankles and feet, and weak pulse in the feet are some of the signs and symptoms of PAD.
Rheumatic Heart Disease.This condition is damage to the heart valves and other heart structures due to inflammation and scarring caused by rheumatic fever, which occurs from streptococcal infection.Heart disease is an umbrella term for a number of different diseases affecting the heart.Heart disease is a number of abnormal conditions affecting the heart and the blood vessels in the heart.